HomeMy WebLinkAboutDriveway Street Cut Permits 182 Pleasant TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4072 Contva'dEor
Location 0182 gym` ' QUALITY FASTING CO.
A d_xeS, 194 :5::. .FAIN STREET
Type Work DRIVEWAY
ET,., WINFf'$OR 06088
Phone Na ;(Sj523 A .&;2
Date Insp Needed
Time Insp Needed
Inspected By p1
Work in Progress
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Permit No. 4072 Town of South Windsor, CT
Date 08/26/2005 Street Excavation Permit
Expiration Date 08/26/2006 "
Descrip:
Applicant
Loeat�oti
Name QUALITY PAVING CO. OY82' PLEASANT7ALTEY
Addr. 194 S. MAIN STREET
EAST WINDSOR Cf (}6088 <";Try a SPc�r A-22FrEiY
Phone (860)523-4182
is
Applicant agrees'.to fur4.4,:g the �o a7 q S t Wind ox he,amount of bond
required and to reimbii'rse"::>a1a�<.# ovs ".:'::; :'i<P"':"''
Sp s d ax fps aii expexhses
incurred by the Town• f.or maitenanc� or`repairs�*s?zznectiQn with this
permit and that a l :c�fi'E 1::... ,..,Y,;;:;•>.::,.:::.;;<;.:a:';:;:...:>::;'_:';:>z- :.:;as:::;;:.;>,..:::,..:i;
PP samzl3A.
ar with art irll:. abide' by tk:e rules and
regulations for permi :S as.:.ottned.., .; 1e !�*e>u!za..;,<of Sauk! V3andsor's Street
Cut Permit Manual.
* * PERMIT wix
TO 13,FKkPT`•.ON 308 ^xI�E' AT AL'L TIMES.
Iss
ued
by
-- 1
Date Completed — Inspected p cted By�
APPLICATION FOR STREET EXCAVATION PERMIT yo7 z
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
Phone No
Address of Firm
Location of proposed work
Liv
Describe fully nature of permit requested
Starting date �f
Approx.time for completion_ �Q
Call Before You Dig No. OSS��-66 Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
r Total Due$ b
f y
CJ ( )Cash( )Check#
/ Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
a
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Date
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: --
Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES